Nurses’ Perceptions of Telephone Triage in Child and Adolescent Psychiatric Services – An Enhanced Critical Incident Technique Study

Figures & data

Table 1. Helping factors – themes and categories.

Category title	Incidents (n = 158)	Participants (n = 8)	Participation rate (%)
A Clear Picture
Distinct symptoms and reduced functions	14	8	100%
Prolonged difficulties or increasing symptoms	10	7	87%
Distinct findings in the BCFPI	13	7	87%
Additional information via previous contact with the CAMHS or referrals	7	5	62%
School confirms difficulties	5	4	50%
Non-complexity	3	3	37%
Heredity	5	3	37%
The context of the child complements the assessment	1	1	12%
The Guardian’s Competencies
Guardian seems stable and competent	6	5	62%
Consensus between the guardian and the BCFPI	4	4	50%
Guardian with knowledge of the child	6	4	50%
Guardian with good communication skills	4	3	37%
Guardian conveys a clear picture of the course e of events	3	3	37%
Help-seeking guardian susceptible to advice	3	3	37%
Dialogue with child before contact	2	2	25%
Guardian who acknowledges the child’s problems	1	1	12%
Guardians have deeper knowledge of their younger children	1	1	12%
The Child’s/Adolescent Capability
Speaking directly with the child/adolescent	12	8	100%
Children/adolescents with insight and communication skills	9	6	75%
It’s easier to ask the child/adolescent about depression, self-harm and suicidal thoughts	5	4	50%
Adolescents who consent to contact with guardians when self-referring	3	2	25%
The Nurse’s Skills
Experience and trusting in one’s own assessment	12	7	87%
Collegial support	7	7	87%
Alliance with guardian	7	5	62%
Remaining neutral and keeping values and feelings in check	2	2	25%
The assessment of the phone call is crucial	2	2	25%
The Context of the Call Facilitates
Direct questions and structure	7	4	50%
Possibility to pause	2	2	25%
Performing the assessment with one guardian	2	2	25%

BCFPI: Brief Child and Family Phone Interview form; CAMHS: Child and Adolescent Mental Health Services.

Table 2. Hindering factors – themes and categories.

Category title	Incidents (n = 147)	Participants (n = 8)	Participation rate (%)
A Blurred Picture
Context of the child	15	8	100%
The BCFPI doesn’t correspond to the description	8	5	62%
Vague symptoms and reason for contact	4	3	37%
Difficulties in assessing and triaging eating disorders	4	3	37%
Assessing psychiatric symptoms in children with somatic diseases or congenital disabilities	2	2	25%
The Guardian’s Limitations
Language barriers	13	8	100%
Guardian unable to describe the difficulties of the child	8	7	87%
Uncertainty regarding guardian’s capability vs the child’s problems – who needs help?	5	5	62%
Guardian who over- or underestimates the child’s difficulties	5	4	50%
Unstable or distraught guardian	6	4	50%
Guardian’s way of describing the child affects triage	5	4	50%
Guardian know less about adolescents	4	3	37%
Lack of insight in guardians regarding children with eating disorders	6	2	25%
The Child´s /Adolescent´s incapability
Children/adolescents in need of the CAMHS who refuse contact and rights to be involved	5	4	50%
Adolescent´s consent is required for contact with guardians	4	3	37%
Not being able to speak with the child/adolescent directly	3	2	25%
Children/adolescents with poor communication skills	3	2	25%
The Nurse’s Challenges
Disagreement between the guardian’s and the nurse’s assessment of the problem	7	5	62%
Ethical dilemmas in triage	6	4	50%
Cultural differences in views of children and mental health	2	2	25%
Intentionally triaging incorrectly to establish or maintain trust	2	2	25%
Performing suicide assessment via telephone	1	1	12%
Difficulties interpreting interface between primary and specialised CAMHS care	1	1	12%
The Context of the Call Complicates
External factors and lack of time	9	7	87%
The BCFPI isn’t applicable when guardian has problems reading Swedish, or for adolescent	3	3	37%
Legal issues	5	3	37%
Adolescents must write their own digital self-referrals	4	2	25%
Misinterpretation of questions in the BCFPI	3	2	25%
Participation of both guardians	2	2	25%
Uncertainty when assessing the use of sign language interpreter	2	2	25%

BCFPI: Brief Child and Family Phone Interview form; CAMHS: Child and Adolescent Mental Health Services.

Table 3. Categories of ‘wish-list’ items.

Category title	Incidents (n = 16)	Participants (n = 8)	Participation rate %
Self-screening for adolescents	5	3	37%
Improved information to guardians prior to contact	2	2	25%
That the same routines apply to all CAMHS units	2	2	25%
Improved information to schools, social services and other s	1	1	12%
To always speak with the child/adolescent directly	2	1	12%
To be able to reach the CAMHS units via VIP telephone when needed	1	1	12%
Improved format for documentation	1	1	12%
To be able to conduct telephone interviews using interpreter	1	1	12%
To be able to work part time with other tasks to maintain commitment	1	1	12%

CAMHS: Child and Adolescent Mental Health Services; VIP: prioritised direct line.